多层螺旋CT导航定位测量复杂性胫骨平台骨折的置钉位置

Multislice spiral CT navigation of screw placement after complex tibial plateau fracture

背景:目前胫骨平台骨折治疗过程中置钉时缺乏理想的导航定位方法。相关研究显示,多层螺旋CT重建影像在复杂性胫骨平台骨折置钉导航定位中效果理想,但是尚未得到证实。目的:探讨多层螺旋CT重建影像在复杂性胫骨平台骨折置钉导航定位中的应用效果。方法:选择郑州大学第五附属医院2014年11月至2015年12月收治的80例复杂性胫骨平台骨折患者资料进行研究,均采用空心钉结合髓内钉内固定治疗,随机分为2组,每组40例。X射线组采用X射线置钉导航定位,螺旋CT组采用多层螺旋CT重建影像置钉导航定位。通过比较2组患者的骨折修复效果评估多层螺旋CT重建影像的置钉导航定位作用。结果与结论:(1)螺旋CT组骨折部位、骨折粉碎程度、骨折移位情况以及骨缺损程度的满意度评分均显著高于X射线组(P<0.05);(2)螺旋CT组患者采用多层螺旋CT定位导航过程中的手术时间、出血量、术后引流量均显著少于X射线组(P<0.05);(3)螺旋CT组一次螺置钉成功率显著高于X射线组(P<0.05);螺旋CT组置钉2次以上者显著少于X射线组(P<0.05);(4)螺旋CT组手术后并发症发生率为8%,显著低于对照组的18%(P<0.05);(5)结果提示,多层螺旋CT重建影像在复杂性胫骨平台骨折置钉中导航效果理想,能确定置钉的准确位置并进行导航,从而准确置入螺钉,提高治愈率,促进复杂性胫骨平台骨折的早期恢复。

BACKGROUND： At present, it lacks the ideal pedicle screws navigation method during screw placement for tibial plateau fractures. Related research showed that： multislice spiral CT reconstruction image has desired effect in navigation and positioning of pedicle screws after complex tibial plateau fractures, but has not yet been confirmed. OBJECTIVE： To study the application effects of multislice spiral CT imaging in navigation and positioning of pedicle screws after complex tibial plateau fractures. METHODS： Eighty cases of complex tibial plateau fractures were selected from the Fifth Affiliated Hospital of Zhengzhou University from November 2014 to December 2015. All patients were treated with internal fixation with hollow nail and intramedullary nail. All patients were randomly divided into two groups, with 40 in each group. In the X-ray group, X-ray was used for screw navigation. In the spiral CT group, multislice spiral CT was used for screw navigation. The navigation effect of multislice spiral CT was assessed by comparing the repair effects between the two groups. RESULTS AND CONCLUSION：（1） In the spiral CT group, fracture site, the degree of comminution, bone fracture displacement, and impairment score were significantly higher than in the X-ray group（P〈0.05）.（2） Surgery time, blood loss, and postoperative drainage were significantly less in the spiral CT group than in the X-ray group（P〈0.05）.（3） Success rate of pedicle screws at the first time was significantly higher in the spiral CT group than in the X-ray group（P〈0.05）. The success rate of pedicle screws at least twice was significantly less in the spiral CT group than in the X-ray group（P〈0.05）.（4） Complication rate was significantly lower in the spiral CT group（8%） than in the control group（18%）（P〈0.05）.（5） These findings suggested that spiral CT image reconstruction of complex tibial plateau fractures pedicle screw showed the desired effect, could determine the exact location and navigation of pedicle screws. The screws can be placed accurately, improve the cure rate, and promote early recovery of complex tibial plateau fracture.